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UNABLE TO CARE FOR SELF

By Ralph Weaver,2014-08-12 19:50
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UNABLE TO CARE FOR SELF ...

PROJECT ASSIST 1.2007

    SCREENING GUIDE

    1

    Mental Health - Total Mental Health Score must be 3 or greater to warrant Face to Face Assessment

    Depressed mood most of the day, diminished interest or pleasure in Depressive Symptoms

    activities, significant weight loss or weight gain, insomnia or

    hypersomnia, psychomotor agitation or retardation, loss of energy,

    feelings of worthlessness, diminished ability to think or concentrate,

    recurrent thoughts of death.

    1 - Mild ; Characterized by the presence of 5-6 depressive symptoms and mild

    disability

    2 - Moderate ; Characterized by the presence of 7-8 depressive symptoms and

    moderate disability

    3 - Severe ; Characterized by the presence of most of the depressive symptoms and a

    clear observable disability

    Inflated self-esteem, decreased need for sleep, more talkative, flight of Manic Symptoms

    ideas, distractibility, psychomotor agitation, excessive involvement in

    pleasurable activities that have potential for painful consequences.

    1 - Mild ; Characterized by the presence of 1-2 manic symptoms and mild

    disability

    2 - Moderate ; Characterized by the presence of 3-4 manic symptoms and moderate

    disability

    3 - Severe ; Characterized by the presence of most manic symptoms and clear,

    observable disability

    Hallucinations, delusions, disorganized thoughts, grossly disorganized Psychotic Symptoms

    or catatonic behavior, inappropriate or flattened affect, lack of insight.

    1 - Mild ; Characterized by the presence of 1-2 psychotic symptoms and mild

    social or occupational dysfunction

    2 - Moderate ; Characterized by the presence of 3-4 psychotic symptoms and moderate

    social or occupational dysfunction

    3 - Severe ; Characterized by the presence of most of the psychotic symptoms and

    severe social or occupational dysfunction

    The development of multiple cognitive deficits manifested by both (1) Cognitive Impairment

    memory impairment (impaired ability to learn new information or to

    recall previously learned information)

    (2) one (or more) of the following cognitive disturbances:

     (a) aphasia (language disturbance)

     (b) apraxia (impaired ability to carry out motor activities despite

    intact motor function)

     (c) agnosia (failure to recognize or identify objects despite intact

    sensory function)

     (d) disturbance in executive functioning (i.e., planning, organizing,

    sequencing, abstracting)

    1 - Mild ; Characterized by the presence of memory and cognitive disturbance

    with mild social or occupational dysfunction

    2 - Moderate ; Characterized by the presence of memory and cognitive disturbance

    with moderate social or occupational dysfunction

    3 - Severe ; Characterized by the presence of memory and cognitive disturbance

    with severe social or occupational dysfunction

PROJECT ASSIST 1.2007

    SCREENING GUIDE

    2

    Risk Factors Warrant a Face to Face Assessment Suicidal Thoughts

    Include but are not limited to: ; Some thoughts of self-harm have been experienced in the past week

     ; Periodic thoughts of self-harm are experienced daily

     ; Frequent and intrusive thoughts of self-harm are experienced

    throughout each day

Suicidal Plan

    Include but are not limited to: ; Plan to harm self is superficial; has some knowledge of method and

    place as demonstrated by the actual effort or plan.

     ; The explicit intent to harm self is apparent.

    ; Some preparation in evidence as in efforts to accumulate medication,

    obtain a gun, but no setting of time or place

     ; Advanced preparation to harm self with respect to availability of

    method, place, and time

Suicidal Intent

    Include but are not limited to: ; Ambiguous desire to end own life

     ; Has desire to end own life in near future

     ; Strong desire to end own life today and has means to do so

Thought of Violence

    Include but are not limited to: ; Some thoughts of causing harm to another in the past week

     ; Periodic thoughts of causing harm to another daily

     ; Frequent and intrusive thoughts to cause harm to another each day

Threats of Violence

    Include but are not limited to: ; Plan for violence is superficial; has some knowledge of method and

    place as demonstrated by the actual effort or plan

     ; Explicit intent of violence is apparent

    ; Some preparation is evidence but no setting of time or place

     ; Advanced preparation of violence with respect to availability of

    method, place, and time

Violent Behavior

    Include but are not limited to: ; Has caused physical harm to an object

     ; Has caused physical harm to another person within the last week

     ; Has caused harm to another person today

PROJECT ASSIST 1.2007

    SCREENING GUIDE

    3

    Risk Factors Total Risk Factor Score must exceed 6 to warrant Face to Face Assessment

Homeless

    1- Mild ; Will be evicted or will be unable to stay in current location in 1 week

    or less

    2 - Moderate ; Currently in homeless or crisis shelter with no place to go upon release

    3 - Severe ; Currently living on the streets, car or other uninhabitable structure

    SUBSTANCE ABUSE Tolerance to the substance, withdrawal syndrome for the substance, the SYMPTOMS substance is often taken in larger amounts or over a longer period than

    was intended, there is a persistent desire or unsuccessful efforts to cut

    down or control substance use, a great deal of time is spent in activities

    necessary to obtain the substance, use the substance or recover from its

    effects, important social, occupational, or recreational activities are

    given up or reduced because of substance use, the substance use is

    continued despite knowledge of having a persistent or recurrent

    physical or psychological problem that is likely to have been caused or

    exacerbated by the substance.

    1- MILD ; Characterized by the presence of 1-2 symptoms of substance abuse with

    mild social or occupational dysfunction

    2 - MODERATE ; Characterized by the presence of 3-4 symptoms of substance abuse with

    moderate social or occupational dysfunction

    3 - SEVERE ; Characterized by the presence of most of the symptoms of substance

    abuse with severe social or occupational dysfunction

    UNABLE TO CARE FOR Requires “hands- on” assistance with personal care, grooming feeding, SELF transferring, medications compliancy, use of cooking utensils, money

    management, and household management.

    1- MILD ; Needs hands on assistance with IADL’s (Homemaking, phone,

    transportation, access to medical care)

    ; Needs verbal directions to complete tasks such as monthly bill

    payment, running errands, shopping, picking up medications,

    arranging for medical appointments or care

    2 - MODERATE ; Intermittent supervision does not require 24 hr. supervision

    ; Needs hands on assistance with self help skills (personal care,

    grooming, dressing, mobility or transferring).

    ; Limited mobility/unsteady gait/history of falls

    ; Inadequate decision-making skills

    ; Abuse/ misuse of OTC and prescribed medications for non-life

    threatening conditions

    3 - SEVERE ; Requires 24 hr. supervision to prevent harm to self.

    ; Dependant on others for self help - ADL’s (personal care, grooming,

    dressing, mobility or transferring).

    ; Abuse or misuse of prescribe medications, life threatening

    conditions

    ; Dependent on others for financial planning

    ; Dependent on others for medication regime

PROJECT ASSIST 1.2007

    SCREENING GUIDE

    4

    Limited or no access to social contact with other people. SOCIAL ISOLATION

    1 - MILD ; Lack of affection to emotion toward elder

    ; Restricted amount of socialization contact with others 2 - MODERATE ; Prevent/discourage elder from speaking to or seeing visitors (undue

    influence).

    ; Anger, indifference, aggressive behavior toward elder

    ; Increased withdrawal i.e. stops attending social functions, doesn’t

    leave the home

    3 - SEVERE ; Irrational fear/mental illness results in the inability to leave home or

    act in best interest

    ; Physical disability prevents person from leaving

    ; Caregiver will not allow communication outside the home or to

    leave

HIGH RISK Defined as unsatisfactory/ unsafe housing.

    ENVIRONMENT

    1- MILD ; Exterior or interior in poor repair i.e. chipped paint, broken steps

    ; Old newspapers lying about i.e. piled on the porch

    ; Walkways not shoveled

    ; Grass not cut

    2 - MODERATE ; Little or no food i.e. little or no food in the refrigerator

    ; Home needs minor repairs/habitable

    ; Strong odors i.e. urine and other foul odors, including pet odors

    ; Many pets or animals appear neglect

    ; Garbage or litter i.e. on the inside and or on the outside of the

    house, bagged or not bagged

    3 - SEVERE ; Home needs major repairs/uninhabitable

    ; No indoor water supply

    ; No toilet facilities or un usable

    ; No heat or un-usable

    ; Other utilities lacking

    ; Pending eviction

    ; Weapons in the home

    ; Pest infestation

    ; Multiple animals/pets

    RECENT LOSS OF New loss of a central relationship resulting emotional disturbance. SIGNIFICANT OTHER

    1 - MILD ; Change in care giver health status unable to perform care giver

    duties

    ; Change in mental health status causing emotional distress/fatigue.

    ; Limited to change in access to significant other. 2 - MODERATE ; Mourning the loss of pet(s).

    ; Hospitalization/temporary nursing placement.

    3 - SEVERE ; Desertion of an elderly person by an individual who has assumed

    responsibility for providing care for an elder, or by a person with

    physical custody of an elder.

    ; Unexpected /sudden death.

PROJECT ASSIST 1.2007

    SCREENING GUIDE

    5

FINANCIAL CRISIS Defined as limited/no access to finances.

    1- MILD ; Insufficient funds limited access to food, shelter medical

    care/insurance.

    2 - MODERATE ; Insufficient or misuse of funds negative impact on ability to

    financially mange daily needs; shelter, food medical care/insurance.

    3 - SEVERE ; No income - loss of payment source, job, SSI, public assistance

    ; Able to pay for shelter, utilities bills, food and or medical

    care/insurance.

    DETERIORATING HEALTH Unstable or worsening health condition resulting gin limited function

    status.

    1- MILD ; 3 or Chronic illness

    ; Multiple medicine bottles

    2- MODERATE ; Inappropriate use of 911- paramedics

    ; Marked change in overall ability to function i.e. not able to

    care for self, i.e. dress, cook

    ; Loss of hearing or sight i.e. macular degeneration, unable to

    see , poor hearing

    ; Chronic or acute physical illness i.e. heart disease, diabetes,

    urinary infection, mal nutriment

    3- SEVERE ; Multiple emergency rooms visits or hospitalizations

    ; Inability to move easily i.e. may need to use a walker or cane,

    may have an amputation, arthritic

    ; Loss of bladder or bowel control. i.e. unable to make it to the

    bathroom, does not know when they are eliminating

    LACK OF/ INADEQUATE Defined as unsatisfactory care provision to elder/vulnerable dependent CARE GIVER person .

    1 - MILD ; Unreliable/inconsistent care

    ; Sometimes avoid or neglects care giver responsibilities

    ; Withholds affection

    ; Talks of elder as a burden

    2 - MODERATE ; Sometimes incapacitated due to ETOC/substance abuse, or history

    of mental illness

    ; Lack of experience/knowledge of care giving role/responsibilities

    ; Intermittent desertion

    3 - SEVERE ; Physically/mentally unable to provide needed care

    ; History of criminal behavior, or family violence

    ; Lack of/ no primary care giver

PROJECT ASSIST 1.2007

    SCREENING GUIDE

    6

    PHYSICALLY ABUSED Defined as the use of physical force that may result in bodily injury,

    physical pain, or impairment.

    1 - MILD ; Hit, slap, kick, rough handling, grabbing, pulling hair

    ; Minor or unnoticeable injury that and may not require medical

    attention.

    ; Injury that is inconsistent with explanation for its cause

    ; Pain from touching

2 - MODERATE ; acts of violence as striking (with or without an object), hitting,

    beating, pushing, shoving, shaking, slapping, kicking, pinching, and

    burning,

    ; inappropriate use of drugs and physical restraints, force-feeding, and

    physical punishment of any kind,

    ; broken eyeglasses/frames, physical signs of being subjected to

    punishment,

    ; Noticeable injuries and may require medical attention.

3 - SEVERE ; bruises, black eyes, welts, lacerations, and rope marks;

    ; bone fractures, broken bones, and skull fractures;

    ; open wounds, cuts, punctures, untreated injuries in various stages of

    healing;

    ; sprains, dislocations, and internal injuries/bleeding;

    ; laboratory findings of medication overdose or under utilization of

    prescribed drugs,

    ; Requires immediate medical attention.

    EMOTIONALLY ABUSED Defined as the infliction of anguish, pain, or distress through verbal or

    nonverbal acts.

    1 - MILD ; Verbal assaults, insults, threats, intimidation, humiliation, and

    harassment

    ; Intimidation tactics threats of nursing home placement or

    imminent harm.

    ; Treating an older person like an infant

    2 - MODERATE ; Isolating an elderly person from his/her family, friends, or regular

    activities;

    ; Giving an older person the "silent treatment;" and enforced social

    isolation.

3 - SEVERE ; Being emotionally upset or agitated;

    ; Causing mental anguish, harsh orders, threats of punishment

    ; Gesturing w/a weapon, threats of imminent harm or abandonment

    ; Undue Influence power & control.

PROJECT ASSIST 1.2007

    SCREENING GUIDE

    7

    SEXUALLY ABUSED Defined as non-consensual sexual contact of any kind with an elderly

    person. Sexual contact with any person incapable of giving consent.

    MILD ; Sexually explicit language/photographing

    MODERATE ; Inappropriate contact, unwanted touching

    ; coerced nudity

    SEVERE ; Bruises around the breasts or genital area

    ; Unexplained venereal disease or genital infections

    ; Unexplained vaginal or anal bleeding

    ; Torn, stained, or bloody underclothing

    NEGLECTED Defined as the refusal or failure to fulfill any part of a person's

    obligations or duties to an elder.

    1- MILD ; Unkempt, dirty or uncombed hair, unshaven

    ; Dirty clothes

    ; Inappropriate dress for the weather (i.e. no coat, outside wandering)

    ; Body odors

    ; Unkempt environment, poor nutrition, inconsistent with providing

    access to medical care.

    2- MODERATE ; Refusal or failure to provide an elderly person with such life necessities

    as food, water, clothing, shelter, personal hygiene, medicine, comfort,

    personal safety.

    ; Unattended or untreated medical care resulting in health problems and

    mal nourishment/weight loss.

    ; Unsanitary and unclean living conditions (e.g. dirt, fleas, lice on person,

    soiled bedding, fecal/urine smells, inadequate clothing).

    3- SEVERE ; Dehydration, malnutrition, untreated bed sores, and poor personal

    hygiene.

    ; Hazardous or unsafe living condition/arrangements (e.g., improper

    wiring, no heat, or no running water.

    SELF-NEGLECT Characterized as the behavior of an elderly person that threatens

    his/her own health or safety.

    1- MILD ; Inappropriate and/or inadequate clothing, lack of the necessary

    medical aids (e.g., eyeglasses, hearing aids, dentures).

    2- MODERATE ; Refusal or failure to provide self with adequate food, water,

    clothing, shelter, personal hygiene, medication (when indicated), and

    safety precautions.

    ; Unsanitary or unclean living quarters (e.g., animal/insect

    infestation, no functioning toilet, fecal/urine smell)

PROJECT ASSIST 1.2007

    SCREENING GUIDE

    8

    EXPLOITED Defined as the illegal or improper use of an elder's funds, property, or

    assets.

    1 - MILD ; Fraudulent or the provision of services that is not necessary.

    2 - MODERATE ; Sudden changes in bank account or banking practice, including an

    unexplained withdrawal of large sums of money by a person

    accompanying the elder.

    ; Unexplained disappearance of funds or valuable possessions.

    ; Cashing an elderly person's checks without authorization or

    permission; forging an older person's signature.

    3 - SEVERE ; Signature being forged for financial transactions or for the titles of

    his/her possessions

    ; Misusing or stealing an older person's money or possessions;

    coercing or deceiving an older person into signing any document

    (e.g., contracts or will)

    ; Improper use of conservatorship, guardianship, or power of

    attorney

    ; Inclusion of additional names on an elder's bank signature card

    ; Unauthorized withdrawal of the elder's funds using the elder's ATM

    card

    ; Abrupt changes in a will or other financial documents

    ; Substandard care being provided or bills unpaid despite the

    availability of adequate financial resources

    ; Sudden appearance of previously uninvolved relatives claiming

    their rights to an elder's affairs and possessions

    ; Unexplained sudden transfer of assets to a family member or

    someone outside the family.

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